36C26119Q0704-008.pdf

TOTAL EVALUATED PRICE CALCULATION DOCUMENT

Instructions

As Described in the Evaluation Criteria (FAR 52.212-2 Evaluation – Commercial Items) Price shall be evaluated based on the offeror’s AWP Price book, Proposed Discounts and Dispensing Fees, the government will calculate based on the sample set of prescription data. The attachments show a sample of the top 10 Name Brand and top 10 Generic drugs that have been prescribed in the last 12 months by the VA Central California Health Care System (VACCHCS) and CBOC’s.

The government will utilize the offeror’s AWP Price Book Values, Prosed Discount Factors and Dispensing Fee identified from the schedule. The numbers identified in Column’s A, B, and C are based on the approximate numbers for the drugs ordered over the past 12 months. The government will fill in the proposed AWP price book values, % discount rate and dispensing fee for each ordering period.

Once the proposed values are filled, the spreadsheet will calculate the Total Cost per item and the Total Evaluated Price for your offer, for all items and ordering periods.

These calculation worksheets are for price evaluation purposes only and does not reflect the actual prescriptions or quantities or associated costs that will be ordered under the resultant contract.

Refer to the following worksheets

TOP 10 Generic Example Worksheet

TOP 10 Brand Name Example Worksheet.

AWP Pricing Book name:____________ Generic Prescription

I II III IV V VI VII VIII IX X

QTY AWP

Generic Prescription Minimum Discount from AWP Multiply Column II times Column III Contractor Generic Price Total Claims

Dispensing fee per prescription

Multiply Column VI times Column VII

Multiply Column I times

Column V

Add total of Column VIII and IX: Total Est. Annual Cost per Prescription

1 AZITHROMYCIN TAB 250MG 3 X 6 6 0% ‐$ ‐$ 253 ‐$ ‐$ ‐$ ‐$

2 CEPHALEXIN 500MG CAPSULE 500CT 40 0% ‐$ ‐$ 159 ‐$ ‐$ ‐$ ‐$

3 BENZONATATE 100MG CAPSULES 500CT 30 0% ‐$ ‐$ 148 ‐$ ‐$ ‐$ ‐$

4 PREDNISONE 20MG TABLETS 100CT 10 0% ‐$ ‐$ 109 ‐$ ‐$ ‐$ ‐$

5 AMOXICIL CLV 875/125 20CT 20 0% ‐$ ‐$ 101 ‐$ ‐$ ‐$ ‐$

6 SULFAMET+TRIM 800/160MG 500CT 14 0% ‐$ ‐$ 89 ‐$ ‐$ ‐$ ‐$

7 FLUTICASONE PROP 50 MCG SPRAY 1 0% ‐$ ‐$ 88 ‐$ ‐$ ‐$ ‐$

8 AMOXICIL CAP 500MG 500CT 30 0% ‐$ ‐$ 87 ‐$ ‐$ ‐$ ‐$

9 DOXYCYC HYC CAP 100MG 50CT 14 0% ‐$ ‐$ 83 ‐$ ‐$ ‐$ ‐$

10 CIPROFLOX TAB 500MG 100CT 20 0% ‐$ ‐$ 82 ‐$ ‐$ ‐$ ‐$

Minimum discount rate for all other prescriptions 0%

Dispensing Fee for all other prescriptions ‐$

Total prices will be evaluated based on the offeror's Proposed Discounts and Dispensing Fees and calculated based on the sample set of prescription data found in the worksheet. The minimum proposed discount rates and dispensing fees for the identified items above will not change for the period of performance you are quoting. However, higher discount rates may be offered at any time but at no time will be lower than the proposed rate for the period of performance quoted.

EXAMPLE

AWP Pricing Book name:____________

Name Brand Prescription

I II III IV V VI VII VIII IX X

QTY AWP

Name Brand Prescription Minimum Discount from

Multiply Column II times Column III

Contractor Brand Name Price Total Claims

Dispensing fee per prescription

Multiply Column VI times Column VII

Multiply Column I times Column V

Add total of Column VIII and IX: Total Est. Annual Cost per Prescription

1 COMBIVENT RESPIMAT 120 DSE 1 0% ‐$ ‐$ 44 ‐$ ‐$ ‐$ ‐$

2 VENTOLIN HFA 1 ‐$ ‐$ 27 ‐$

SYMBICORT AEROSOL 160‐4.5 MCG

INHALER 1 0% ‐$ ‐$ 17 ‐$ ‐$ ‐$ ‐$

4 MUCINEXTAB 600MG ER 100CT 1 ‐$ ‐$ 7 ‐$

5 SYMBICORT MDI 80/4.5MCG 120DO 1 0% ‐$ ‐$ 5 ‐$ ‐$ ‐$ ‐$

6 ATROVENT HFA INH AERO 12.9GM 1 0% ‐$ ‐$ 5 ‐$ ‐$ ‐$ ‐$

7 ELIQUIS 5MG TABLET 60CT 20 0% ‐$ ‐$ 4 ‐$ ‐$ ‐$ ‐$

8 SPIRIVA HANDIHALER 30 1 0% ‐$ ‐$ 4 ‐$ ‐$ ‐$ ‐$

9 STIOLTO RESPIMAT 60 DOSE 1 0% ‐$ ‐$ 3 ‐$ ‐$ ‐$ ‐$

10 PROAIR HFA MDI W/COUNTER 8.5GM 1 0% ‐$ ‐$ 3 ‐$ ‐$ ‐$ ‐$

Minimum discount rate for all other prescriptions 0%

Dispensing Fee for all other prescriptions ‐$

Total prices will be evaluated based on the offeror's Proposed Discounts and Dispensing Fees and calculated based on the sample set of prescription data found in the worksheet. The minimum proposed discount rates and dispensing fees for the identified items above will not change for the period of performance you are quoting. However, higher discount rates may be offered at any time but at no time will be lower than the proposed rate for the period of performance quoted

EXAMPLE